Author(s): BORGES COSIC, M., AGUILERA-GARCÍA, I., LÓPEZ-CORCHÓN, M., TSIARLESTON, G., SEGURA-JIMÉNEZ, V., Institution: UNIVERSIDAD DE CÁDIZ, Country: SPAIN, Abstract-ID: 1675

INTRODUCTION:
Sleep disturbances are common among individuals with chronic primary low back pain (CPLBP), with 59% of them experiencing poor sleep quality (1). This study aimed to study the sequential effects of a two-phase multimodal intervention compared with a control group on sleep quality in individuals with CPLBP within the HEALTHYBACK randomized controlled trial (2).
METHODS:
Seventy participants with CPLBP were randomized; per-prtocol analysis included individuals attendeding ≥65% of sessiones (mean age 51.1 ± 10.8 years; 39 women): control group (CG, n=33), and multimodal intervention group (MG, n=23). The IG completed a 16-week two-phase intervention conducted in hospital setting. Phase I (8-week) comprosed supervised physical exercise (2 sessions/week, 45 min), mindfulness-based stress reduction (1 session/week, 2.5 h), pain neuroscience education (biweekly, 2.5 h) and daily behaviour change supported by a wrist-worn activity prompting device. Phase II (8 weeks) consisted of supervised functional full-body muscle strengthening exercise (3 sessions/week, 45 min). The CG maintained usual lifestyle habits. Sleep quality (0-21, higher scores represent poorer sleep quality) was assessed using the Pittsburgh Sleep Quality Index at baseline, after Phase I, and after Phase II. Within-group changes were examined using repeated-measures ANOVA. Between-group differences in change scores (post–pre and post2–pre) were analyzed using ANCOVA adjusted for baseline values.
RESULTS:
Within-group analyses showed significant improvements in sleep quality after Phase I (mean difference = −1.96; 95% CI −3.33 to −0.59, p=0.070) and demonstrated greater improvements following Phase II (−2.61; 95% CI −4.16 to −1.06, p=0.020) in the IG. No significant changes were observed in the CG across time points. Between-group analyses (ANCOVA on change scores) revealed significantly greater reductions in sleep quality in the IG compared with the CG after Phase I (adjusted mean difference in change = −1.90; 95% CI −3.65 to −0.15; p=0.034) and after Phase II (−1.76; 95% CI −3.37 to −0.15; p=0.033).
CONCLUSION:
A structured two-phase multimodal intervention, followed by moderate-to-high intensity functional full-body muscle strengthening exercise, significantly improved subjective sleep quality in individuals with CPLBP compared with usual care. These findings support the potential role of multidimensional exercise-based approaches in addressing sleep disturbances in this population. Future studies incorporating objective sleep assessments (e.g., actigraphy or polysomnography) are warranted to complement these results.

REFERENCES:
(1) Alsaadi SM, et al. Eur Spine J (2011) 20:737–743. doi 10.1007/s00586-010-1661-x
(2) Tsiarleston G, et al. BMJ Open Sp Ex Med 2024;10:e002188. doi:10.1136/bmjsem-2024-002188

FUNDING:
Instituto de Salud Carlos III (CP20/00178 and PI22/01791).